针药结合抗抑郁临床研究及临床文献方法学评价
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摘要
研究背景
抑郁症(Depression)是一种常见的心境障碍或情感障碍,以显著而持久的情感或心境低落为主要特征的疾病。临床上,以思维迟缓、情感低落、兴趣下降为主,常伴有相应的认知和行为改变。近年来随着生活节奏的不断加快,竞争压力的不断加大,抑郁症的发病率呈明显上升趋势。临床上针灸治疗抑郁症应用广泛,但疗效和安全性尚缺乏足够的高级别证据予以支持。本研究基于循证医学原则,按照规范的随机对照试验设计方法探讨针刺治疗抑郁症的临床效果。
目的
1以针灸治疗抑郁症的不同临床方案与公认阳性药物盐酸帕罗西汀为对照进行临床试验研究,确认针灸治疗抑郁症不同方案在临床具体实践中的确切效果；
2确认不同方案对抑郁症状的改善程度并探究不同针刺方案对抑郁症患者靶症状群的改善情况,分析不同治疗方案抗抑郁的疗效作用特点及优势；
3确认不同治疗方案抗抑郁的起效时间差异；
4探讨抑郁症不同治疗方案对患者生存质量的影响,试图全面评价不同方案对抑郁症患者的健康结局。
5分析针灸治疗抑郁症临床研究文献的研究类型和随机对照临床文献的方法学特征,思考循证医学方法学应用于中医药针灸疗效评价存在的问题。
方法
1临床研究
将2008年6月-2009年9月包头市第六医院精神科门诊和住院病人符合西医诊断标准和纳入标准的72例受试者,按照知情同意原则,对72例受试者中心随机分为三组,电针组23例,手针组32例,药物组17例,应用HAMD量表、SDS量表在治疗0、1、2、4、6周时对患者进行评定,应用SERS量表在治疗0、2、4、6周时对患者进行评定,应用CGI量表、WHOQOL-BREF量表在治疗开始时和治疗结束时对患者进行评定,并在治疗结束后4周时应用HAMD量表对患者进行随访评定,对主要疗效指标采用ITT和PP两种分析方法进行分析,评价针刺不同方案抗抑郁的临床效果和对抑郁症状的改善程度。
2方法学评价
通过中国期刊全文数据库(CNKI)检索1979年至2009年所有针灸治疗抑郁症相关的临床研究文献。对入选文献逐篇进行分析,首先对临床研究文献按照研究性质进行分类,分为随机对照试验、对照试验、病例系列研究和专家经验体会。其次对纳入的随机对照试验临床文献按照循证医学所规定的方法学特征进行整理分析。
结果
1临床研究
1.1 ITT、PP分析结果显示针刺试验组的显效率分别为74.55%、87.23%,药物组的显效率为47.06%、50%,两组的显效率比较具有统计学差异(P<0.05)。
1.2 ITT、PP分析结果显示两组HAMD评分在治疗1、2、4、6周时组间比较均具有显著性差异(P<0.05),针刺组各时段HAMD评分均显著低于药物组。两组治疗后各周HAMD评分与治疗前相比均有显著性差异(P<0.05)。
1.3 ITT分析结果显示电针组、手针组和药物组三组疗效构成,组间差异无统计学意义(P<0.05),但数据显示电针组和手针组的显效率高于药物组显效率。PP分析结果显示三组之间疗效构成,组间差异有统计学意义(P<0.05)。
1.4三组HAMD评分在治疗1、2、4、6周后,三组组间比较均具有显著性差异(P<0.05)。电针组和手针组在治疗后各时间段的HAMD评分均显著性低于药物组HAMD评分。电针组和手针组相比在治疗后各时间段对抑郁症状的改善程度并没有显著性差异。三组治疗后各周HAMD评分与治疗前相比均有显著性差异(P<0.05)。
1.5电针组,手针组和药物组三组在治疗后1,2,4,6周时HAMD焦虑／躯体化因子、睡眠障碍因子评分组间比较均有显著性差异(P<0.05)。三组在治疗后各时间段对HAMD阻滞因子和体重因子的改善程度没有显著性差异。电针组和手针组对认知障碍因子的改善程度在治疗4周时显著优于药物组,其余各时间段,三组HAMD认知障碍因子评分组间比较没有显著性差异(P<0.05)。电针组和手针组对HAMD焦虑／躯体化因子、体重因子、认知障碍因子、阻滞因子、睡眠障碍因子在治疗后各时间段的改善程度均没有显著性差异(P>0.05)。
1.6三组SDS评分在治疗后1周,2周时组间比较没有显著性差异(P>0.05)。在治疗4周,6周后,电针组和手针组SDS评分显著低于药物组。而电针组和手针组SDS评分在各时间段组间比较均没有显著性差异(P>0.05)。
1.7电针组和手针组治疗6周后病情严重程度(SI),疗效总评(GI)和疗效指数(EI)均显著低于药物组。电针组和手针组上述指标两组之间比较没有显著性差异(P>0.05)。
1.8电针组和手针组治疗6周后总的生存质量主观感受、总健康状况主观感受、生理领域、心理领域、环境领域评分的改善程度均显著好于药物组,但电针组和手针组两组之间上述领域评分比较没有显著性差异。在社会关系领域评分方面,治疗结束后三组之间比较并没有显著性差异(P>0.05)。
1.9三组不良事件发生率分别为17.4%,12.5%,23.5%,相互比较无显著性差异(P>0.05)。电针组和手针组在治疗后各时间段SERS评分均显著低于药物组,电针组和手针组两组各时间段SERS评分组间比较没有显著性差异(P>0.05)。
2方法学评价
在纳入的146篇临床研究文献中,随机对照试验临床研究文献为86篇,占所有文献的58.9%；采用对照试验的临床研究文献为18篇,占所有文献的12.3%；病例系列研究型临床文献31篇,占所有文献的21.2%；专家经验体会型文献11篇,占所有文献的7.6%。在纳入的86篇随机对照临床研究文献中,有12篇描述随机序列产生的方法,只有9篇提及了盲法,有4篇使用了安慰剂作为对照组,有20篇文献记录了脱落病例的处理,但没有1篇文献使用ITT分析作为结局指标的统计方法。
结论
1临床研究
1.1针药结合治疗抑郁症的疗效优于单纯盐酸帕罗西汀抗抑郁的疗效。但电针和手针两种干预方式治疗抑郁症的疗效没有显著性差异；
1.2与单用盐酸帕罗西汀相比,针药结合可明显改善患者的抑郁症状；
1.3针刺可明显改善抑郁症患者的焦虑／躯体化因子、睡眠障碍因子等躯体症状。
1.4针药结合对HAMD焦虑／躯体化因子、认知障碍因子、睡眠障碍因子、阻滞因子的起效时间早于单用盐酸帕罗西汀；
1.5针刺可明显改善患者的生存质量,提高患者的自我机能和心理状态；
1.6针刺可减少药物的不良反应,对抑郁症患者可起到减毒增效的作用。
2方法学评价
目前针灸治疗抑郁症随机对照临床试验研究文献方法学质量普遍偏低,一方面是由于研究者对方法学要素没有充分理解,存在着滥用、误用现象,另一方面是由于中西医体系的差异导致循证医学方法学运用中医针灸疗效评价存在着局限性,建议应根据中医临床诊治特点建立适合评价中医针灸疗效的循证医学方法。
Background
With the obvious symptoms of lasting and obvious low mood, depression is a common emotional disorder. In clinic, the major complains lie in the slow reflection, lose of interest and some obvious cognitive and behavior disorders. In recent years, with the ever-growing stress in modern life, depression is getting more and more popular. In the treatment for depression, acupuncture is a commonly applied approach. However, little high level evidence have been found in the effctiveness and safety. In this research, the EBM (evidence-based medicine) based randomized controlled methodology has been applied in the evaluation of clinic effect of acupuncture in the treatment of depression.
Object
1 various acupuncture treatments compared with the commonly recognized controlled medicinal paroxetine hydrochloride in the clinic trials to detect the actual effctiveness of acupuncture treatment in the clinic practice.
2 To confirm various patients'reflections to different acupuncture treatments for analyzing the features and advantages of acupuncture treatment for depression.
3 To testify different effective time of various treatments.
4 To evaluate the influences of various treatments to patients'life quality.
5 To analyze research types of acupuncture to anti-depression clinic literature and the features of randomized controlled literature, find problems in the current situation for the evaluation of traditional Chinese Medicine acupuncture effctiveness based on EBM.
Method
1 Clinical research
From June,2008 to September,2009,72 participants have been selected in the 6th hospital of Baotou City from both the outpatient and inpatient departments. The participants are divided into three groups,23 for electro-acupuncture,32 for acupuncture, and 17 for western medicine. HAMD, SDS and SERS scales have been applied in the evaluation at the 0,1,2,4,6 weeks period. Before and after the treatment, the participants have been evaluated by CGI and WHOQOL-BREF scale.4 weeks after the treatment, the participants have been reviewed according to HAMD.
2 Methodology evaluation
According to the analysis to all the literatures on acupuncture treatment for depression retrieved from 1979 to 2009 from CNKI, the literatures can be classified as randomized controlled trial, controlled trial, case series study and experts'experiences conferences. Of all the randomized controlled trial literatures, the ones which fit the EBM (Evidence-based Medicine) standards are further reviewed.
Results
1 Clinical research
1.1 The ITT and PP analysis showed that effctiveness of acupuncture group are 74.55% and 87.23%, effctiveness for medicinal group are 47.06% and 50%, both of which are significant different (P＜0.05).
1.2 ITT and PP analysis presented the significant difference between two groups at the period of 1,2,4,6 weeks according to HAMD scores. The HAMD scores fro acupuncture are significantly lower than the medicinal group. The significant deference can also be detected after the treatment(P<0.05).
1.3 The ITT analysis showed no statistical meaning was founded from electro-acupuncture, acupuncture and medicinal groups (P>0.05),but the response rate of the electro-acupuncture group and acupuncture group is higher than medicine. However, the PP analysis presented the significant deference in the effctiveness of the three groups (P＜0.05).
1.4 Of the three groups, according to the HAMD scores at the period of 1,2,4,6 weeks, significant differences could be presented. The HAMD scores of electro-acupuncture and acupuncture groups are much lower than the medicinal group. Meanwhile, no significant deference was detected between electro-acupuncture and acupuncture.
1.5 Significant differences have been showed in the anxiety/somatization, sleep disorder factor between three groups at 1,2,4,6 weeks. For the scores of retardation and body weight factors, no significant differences have been detected at all the weeks evaluation.Either after the treatment. Electro-acupuncture and acupuncture presented better effctiveness than before. Except 4 weeks of the treatment, no significant differences have been presented for HAMD cognitive disorder scores.
1.6 No significant difference has been detected after 1 and 2 weeks (P＞0.05). After 4.6 weeks, electro-acupuncture and acupuncture groups presented much lower SDS scores than medicinal group. However, no significant difference has been founded within the electro-acupuncture and acupuncture groups.
1.7 After 6 weeks of treatments, SI, GI and EI of electro-acupuncture and acupuncture groups are much lower than those of medicinal group. No significant differences have been detected within the electro-acupuncture and acupuncture groups.
1.8 Participants'life quality, health sensation, psychology and physical condition as well as the circumstances of electro-acupuncture and acupuncture groups are much better than the medicinal group with no significant difference presented within electro-acupuncture and acupuncture groups. No significant differences of social relationship can be presented within three groups.
1.9 Adverse events rate of three groups are 17.4%,12.5% and 23.5% which are not significantly different. SERS scores of electro-acupuncture and acupuncture groups are much lower than that of medicinal group. Meanwhile the SERS scores of electro-acupuncture and acupuncture groups presented no significant difference.
2 Methodology evaluation
Within the total 146 literatures,86 are randomized controlled trials which weighs 58.9%,18 are controlled trials weighing 12.3%, case series study adds up to 31 weighing 21.2%, the left 11 are experts experiences weighing 7.6%. Of the 86 randomized controlled trials,12 of which described the randomization,9 introduced blinding,4 applied placebo as controlled,20 recorded the losing cases. Only 1 applied ITT analysis as the outcome measurement.
Conclusion
1 Clinical research
1.1 Effctiveness of treatment combined acupuncture and medicine are better than that of paroxetine hydrochloride, with no significant difference can be founded within effctiveness of electro-acupuncture and acupuncture groups.
1.2 Acupuncture can obviously improve the patients'anxiety/somatization, sleeping disorders and cognitive factor.
1.3 Acupuncture can improve patients'living quality, psychological and physical conditions.
1.4 Acupuncture can eliminate the side effects of medicine and detoxine the medicinal treatment for the depression patients.
2 Methodology evaluation
Currently the qualities of literature for the acupuncture treatment of depression are quite low which can be analyzed as the lack understanding of methodology of researchers, and can also be because the limited function of EBM approaches due to the differences between Traditional Chinese Medicine and modern medicine. It is suggested important to establish the EBM evaluation for the Traditional Chinese Medicine acupuncture according to its feature.
抑郁症(Depression)是一种常见的心境障碍或情感障碍,以显著而持久的情感或心境低落为主要特征的疾病。临床上,以思维迟缓、情感低落、兴趣下降为主,常伴有相应的认知和行为改变。近年来随着生活节奏的不断加快,竞争压力的不断加大,抑郁症的发病率呈明显上升趋势。临床上针灸治疗抑郁症应用广泛,但疗效和安全性尚缺乏足够的高级别证据予以支持。本研究基于循证医学原则,按照规范的随机对照试验设计方法探讨针刺治疗抑郁症的临床效果。
目的
1以针灸治疗抑郁症的不同临床方案与公认阳性药物盐酸帕罗西汀为对照进行临床试验研究,确认针灸治疗抑郁症不同方案在临床具体实践中的确切效果；
2确认不同方案对抑郁症状的改善程度并探究不同针刺方案对抑郁症患者靶症状群的改善情况,分析不同治疗方案抗抑郁的疗效作用特点及优势；
3确认不同治疗方案抗抑郁的起效时间差异；
4探讨抑郁症不同治疗方案对患者生存质量的影响,试图全面评价不同方案对抑郁症患者的健康结局。
5分析针灸治疗抑郁症临床研究文献的研究类型和随机对照临床文献的方法学特征,思考循证医学方法学应用于中医药针灸疗效评价存在的问题。
方法
1临床研究
将2008年6月-2009年9月包头市第六医院精神科门诊和住院病人符合西医诊断标准和纳入标准的72例受试者,按照知情同意原则,对72例受试者中心随机分为三组,电针组23例,手针组32例,药物组17例,应用HAMD量表、SDS量表在治疗0、1、2、4、6周时对患者进行评定,应用SERS量表在治疗0、2、4、6周时对患者进行评定,应用CGI量表、WHOQOL-BREF量表在治疗开始时和治疗结束时对患者进行评定,并在治疗结束后4周时应用HAMD量表对患者进行随访评定,对主要疗效指标采用ITT和PP两种分析方法进行分析,评价针刺不同方案抗抑郁的临床效果和对抑郁症状的改善程度。
2方法学评价
通过中国期刊全文数据库(CNKI)检索1979年至2009年所有针灸治疗抑郁症相关的临床研究文献。对入选文献逐篇进行分析,首先对临床研究文献按照研究性质进行分类,分为随机对照试验、对照试验、病例系列研究和专家经验体会。其次对纳入的随机对照试验临床文献按照循证医学所规定的方法学特征进行整理分析。
结果
1临床研究
1.1 ITT、PP分析结果显示针刺试验组的显效率分别为74.55%、87.23%,药物组的显效率为47.06%、50%,两组的显效率比较具有统计学差异(P<0.05)。
1.2 ITT、PP分析结果显示两组HAMD评分在治疗1、2、4、6周时组间比较均具有显著性差异(P<0.05),针刺组各时段HAMD评分均显著低于药物组。两组治疗后各周HAMD评分与治疗前相比均有显著性差异(P<0.05)。
1.3 ITT分析结果显示电针组、手针组和药物组三组疗效构成,组间差异无统计学意义(P<0.05),但数据显示电针组和手针组的显效率高于药物组显效率。PP分析结果显示三组之间疗效构成,组间差异有统计学意义(P<0.05)。
1.4三组HAMD评分在治疗1、2、4、6周后,三组组间比较均具有显著性差异(P<0.05)。电针组和手针组在治疗后各时间段的HAMD评分均显著性低于药物组HAMD评分。电针组和手针组相比在治疗后各时间段对抑郁症状的改善程度并没有显著性差异。三组治疗后各周HAMD评分与治疗前相比均有显著性差异(P<0.05)。
1.5电针组,手针组和药物组三组在治疗后1,2,4,6周时HAMD焦虑／躯体化因子、睡眠障碍因子评分组间比较均有显著性差异(P<0.05)。三组在治疗后各时间段对HAMD阻滞因子和体重因子的改善程度没有显著性差异。电针组和手针组对认知障碍因子的改善程度在治疗4周时显著优于药物组,其余各时间段,三组HAMD认知障碍因子评分组间比较没有显著性差异(P<0.05)。电针组和手针组对HAMD焦虑／躯体化因子、体重因子、认知障碍因子、阻滞因子、睡眠障碍因子在治疗后各时间段的改善程度均没有显著性差异(P>0.05)。
1.6三组SDS评分在治疗后1周,2周时组间比较没有显著性差异(P>0.05)。在治疗4周,6周后,电针组和手针组SDS评分显著低于药物组。而电针组和手针组SDS评分在各时间段组间比较均没有显著性差异(P>0.05)。
1.7电针组和手针组治疗6周后病情严重程度(SI),疗效总评(GI)和疗效指数(EI)均显著低于药物组。电针组和手针组上述指标两组之间比较没有显著性差异(P>0.05)。
1.8电针组和手针组治疗6周后总的生存质量主观感受、总健康状况主观感受、生理领域、心理领域、环境领域评分的改善程度均显著好于药物组,但电针组和手针组两组之间上述领域评分比较没有显著性差异。在社会关系领域评分方面,治疗结束后三组之间比较并没有显著性差异(P>0.05)。
1.9三组不良事件发生率分别为17.4%,12.5%,23.5%,相互比较无显著性差异(P>0.05)。电针组和手针组在治疗后各时间段SERS评分均显著低于药物组,电针组和手针组两组各时间段SERS评分组间比较没有显著性差异(P>0.05)。
2方法学评价
在纳入的146篇临床研究文献中,随机对照试验临床研究文献为86篇,占所有文献的58.9%；采用对照试验的临床研究文献为18篇,占所有文献的12.3%；病例系列研究型临床文献31篇,占所有文献的21.2%；专家经验体会型文献11篇,占所有文献的7.6%。在纳入的86篇随机对照临床研究文献中,有12篇描述随机序列产生的方法,只有9篇提及了盲法,有4篇使用了安慰剂作为对照组,有20篇文献记录了脱落病例的处理,但没有1篇文献使用ITT分析作为结局指标的统计方法。
结论
1临床研究
1.1针药结合治疗抑郁症的疗效优于单纯盐酸帕罗西汀抗抑郁的疗效。但电针和手针两种干预方式治疗抑郁症的疗效没有显著性差异；
1.2与单用盐酸帕罗西汀相比,针药结合可明显改善患者的抑郁症状；
1.3针刺可明显改善抑郁症患者的焦虑／躯体化因子、睡眠障碍因子等躯体症状。
1.4针药结合对HAMD焦虑／躯体化因子、认知障碍因子、睡眠障碍因子、阻滞因子的起效时间早于单用盐酸帕罗西汀；
1.5针刺可明显改善患者的生存质量,提高患者的自我机能和心理状态；
1.6针刺可减少药物的不良反应,对抑郁症患者可起到减毒增效的作用。
2方法学评价
目前针灸治疗抑郁症随机对照临床试验研究文献方法学质量普遍偏低,一方面是由于研究者对方法学要素没有充分理解,存在着滥用、误用现象,另一方面是由于中西医体系的差异导致循证医学方法学运用中医针灸疗效评价存在着局限性,建议应根据中医临床诊治特点建立适合评价中医针灸疗效的循证医学方法。
Background
With the obvious symptoms of lasting and obvious low mood, depression is a common emotional disorder. In clinic, the major complains lie in the slow reflection, lose of interest and some obvious cognitive and behavior disorders. In recent years, with the ever-growing stress in modern life, depression is getting more and more popular. In the treatment for depression, acupuncture is a commonly applied approach. However, little high level evidence have been found in the effctiveness and safety. In this research, the EBM (evidence-based medicine) based randomized controlled methodology has been applied in the evaluation of clinic effect of acupuncture in the treatment of depression.
Object
1 various acupuncture treatments compared with the commonly recognized controlled medicinal paroxetine hydrochloride in the clinic trials to detect the actual effctiveness of acupuncture treatment in the clinic practice.
2 To confirm various patients'reflections to different acupuncture treatments for analyzing the features and advantages of acupuncture treatment for depression.
3 To testify different effective time of various treatments.
4 To evaluate the influences of various treatments to patients'life quality.
5 To analyze research types of acupuncture to anti-depression clinic literature and the features of randomized controlled literature, find problems in the current situation for the evaluation of traditional Chinese Medicine acupuncture effctiveness based on EBM.
Method
1 Clinical research
From June,2008 to September,2009,72 participants have been selected in the 6th hospital of Baotou City from both the outpatient and inpatient departments. The participants are divided into three groups,23 for electro-acupuncture,32 for acupuncture, and 17 for western medicine. HAMD, SDS and SERS scales have been applied in the evaluation at the 0,1,2,4,6 weeks period. Before and after the treatment, the participants have been evaluated by CGI and WHOQOL-BREF scale.4 weeks after the treatment, the participants have been reviewed according to HAMD.
2 Methodology evaluation
According to the analysis to all the literatures on acupuncture treatment for depression retrieved from 1979 to 2009 from CNKI, the literatures can be classified as randomized controlled trial, controlled trial, case series study and experts'experiences conferences. Of all the randomized controlled trial literatures, the ones which fit the EBM (Evidence-based Medicine) standards are further reviewed.
Results
1 Clinical research
1.1 The ITT and PP analysis showed that effctiveness of acupuncture group are 74.55% and 87.23%, effctiveness for medicinal group are 47.06% and 50%, both of which are significant different (P＜0.05).
1.2 ITT and PP analysis presented the significant difference between two groups at the period of 1,2,4,6 weeks according to HAMD scores. The HAMD scores fro acupuncture are significantly lower than the medicinal group. The significant deference can also be detected after the treatment(P<0.05).
1.3 The ITT analysis showed no statistical meaning was founded from electro-acupuncture, acupuncture and medicinal groups (P>0.05),but the response rate of the electro-acupuncture group and acupuncture group is higher than medicine. However, the PP analysis presented the significant deference in the effctiveness of the three groups (P＜0.05).
1.4 Of the three groups, according to the HAMD scores at the period of 1,2,4,6 weeks, significant differences could be presented. The HAMD scores of electro-acupuncture and acupuncture groups are much lower than the medicinal group. Meanwhile, no significant deference was detected between electro-acupuncture and acupuncture.
1.5 Significant differences have been showed in the anxiety/somatization, sleep disorder factor between three groups at 1,2,4,6 weeks. For the scores of retardation and body weight factors, no significant differences have been detected at all the weeks evaluation.Either after the treatment. Electro-acupuncture and acupuncture presented better effctiveness than before. Except 4 weeks of the treatment, no significant differences have been presented for HAMD cognitive disorder scores.
1.6 No significant difference has been detected after 1 and 2 weeks (P＞0.05). After 4.6 weeks, electro-acupuncture and acupuncture groups presented much lower SDS scores than medicinal group. However, no significant difference has been founded within the electro-acupuncture and acupuncture groups.
1.7 After 6 weeks of treatments, SI, GI and EI of electro-acupuncture and acupuncture groups are much lower than those of medicinal group. No significant differences have been detected within the electro-acupuncture and acupuncture groups.
1.8 Participants'life quality, health sensation, psychology and physical condition as well as the circumstances of electro-acupuncture and acupuncture groups are much better than the medicinal group with no significant difference presented within electro-acupuncture and acupuncture groups. No significant differences of social relationship can be presented within three groups.
1.9 Adverse events rate of three groups are 17.4%,12.5% and 23.5% which are not significantly different. SERS scores of electro-acupuncture and acupuncture groups are much lower than that of medicinal group. Meanwhile the SERS scores of electro-acupuncture and acupuncture groups presented no significant difference.
2 Methodology evaluation
Within the total 146 literatures,86 are randomized controlled trials which weighs 58.9%,18 are controlled trials weighing 12.3%, case series study adds up to 31 weighing 21.2%, the left 11 are experts experiences weighing 7.6%. Of the 86 randomized controlled trials,12 of which described the randomization,9 introduced blinding,4 applied placebo as controlled,20 recorded the losing cases. Only 1 applied ITT analysis as the outcome measurement.
Conclusion
1 Clinical research
1.1 Effctiveness of treatment combined acupuncture and medicine are better than that of paroxetine hydrochloride, with no significant difference can be founded within effctiveness of electro-acupuncture and acupuncture groups.
1.2 Acupuncture can obviously improve the patients'anxiety/somatization, sleeping disorders and cognitive factor.
1.3 Acupuncture can improve patients'living quality, psychological and physical conditions.
1.4 Acupuncture can eliminate the side effects of medicine and detoxine the medicinal treatment for the depression patients.
2 Methodology evaluation
Currently the qualities of literature for the acupuncture treatment of depression are quite low which can be analyzed as the lack understanding of methodology of researchers, and can also be because the limited function of EBM approaches due to the differences between Traditional Chinese Medicine and modern medicine. It is suggested important to establish the EBM evaluation for the Traditional Chinese Medicine acupuncture according to its feature.
引文
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1. Simon GE, Barber C, Birnbaum HG, et al. Depression and work productivity: the comparative costs of treatment versus nontreatment[J]. J Occup Environ Med,2001,43 (1):2-9.
2.肖凉,季建林,张寿宝,等.城市人群中抑郁症状及抑郁症的发生率调查分析[J].中国行为医学科学,2000,9(3)：200-201.
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2. Orley J.Quality of Life Assessment:International Perspectives[R].Springer Verlag Berlin Heidelberg,1994.
3. 吕梅,王玲玲.针刺治疗抑郁症选穴频次的分析[J].针灸临床杂志,2003,19(8)：15-16.
4.段冬梅,图娅.百优解与电针对轻、中度抑郁症的有效性评价[J].中国药物应用与监测,2008,5(1)：1-4.
5. 姜劲峰,刘兰英,王俊.针药并用对抑郁症患者HAMD量表因子的影响[J].上海针灸杂志,2007,26(6)：3-5.
6. 汪冰霞,周树平,孙鸿辉.电针合并抗抑郁剂治疗抑郁症的临床观察[J].北京中医杂志,2003,22(2)：5-7.
7. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, et,al. SSRI-induced sexual dysfunction:fluoxetine,paroxetine,sertraline,and fluvoxamine in a prospective, muticenter,and descriptive clinical study of 344 patients[J].Journal of Sex and Marital Therapy,1997,23:176-194.
8. Fisher LD, Dixon DO, HersonJ, etal. Intention to treat in clinical trials.In:PearceKE,ed.Statistical issues in drug research and development. NewYork:Marcel Dekker,1990:331-350.
9.邱艳明,时宇静,图娅.电针印堂、百会对获得性无助大鼠不同脑区内单胺类神经递质的影响[J].北京中医药大学学报,2002,6(25)：54.
10.李卫东,杨秀岩.电针对慢性应激抑郁模型大鼠行为与海马组织环磷酸腺苷水平的影响[J].中国行为医学科学,2007,12(16)：1060.
11.孙海霞,杨蕴萍.抑郁症和焦虑障碍共病的研究现状[J].国外医学,精神病学分册,2003,3：166-169.
12. Heiligenstein JH, Faries DE, Rush AJ, et al. Latency to rapid eye movement sleep as a predictor of treatment response to doxetine and placebo in nonpsychotic depressed outpatients[J]. Psychiatry Research,1994,52:327-339.
13. Hatzinger M, Hemmeter UM, Brand S, et al. Electroencephalografhic sleep profiles in treatment course and long-term outcome of major depression: association with DEX/CRH-test response[J]. Journal of Psychiatric Research, 2004,38(5):453-465.
14. Agargun, MY, Kara H, Solmaz M. Subjective sleep quality and suicidality in patients with major depression[J]. Journal of Psychiatric Research,1997, 31,377-381.
15.郭克峰,郭珊,闫凯麟.帕罗西汀加银杏叶提取物治疗抑郁症的疗效[J].中国行为医学科学.2006,15(8)：704-706.
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[1]裴音,张捷,陈杰,等.针刺王氏五脏俞治疗抑郁症临床观察[J].中国中医药信息杂志,2006,13(6)：62-63.
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[1]唐济湘,关念红,李林,等.电针治疗中风后抑郁的疗效与对患者生存质量的影响[J].上海针灸杂志,2003,22(3)：12-14.
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1. Simon GE, Barber C, Birnbaum HG, et al. Depression and work productivity: the comparative costs of treatment versus nontreatment[J]. J Occup Environ Med,2001,43 (1):2-9.
2.肖凉,季建林,张寿宝,等.城市人群中抑郁症状及抑郁症的发生率调查分析[J].中国行为医学科学,2000,9(3)：200-201.
1. 张明园.精神科评定量表手册[M].长沙,湖南科学技术出版社,1998：125.
2. Orley J.Quality of Life Assessment:International Perspectives[R].Springer Verlag Berlin Heidelberg,1994.
3. 吕梅,王玲玲.针刺治疗抑郁症选穴频次的分析[J].针灸临床杂志,2003,19(8)：15-16.
4.段冬梅,图娅.百优解与电针对轻、中度抑郁症的有效性评价[J].中国药物应用与监测,2008,5(1)：1-4.
5. 姜劲峰,刘兰英,王俊.针药并用对抑郁症患者HAMD量表因子的影响[J].上海针灸杂志,2007,26(6)：3-5.
6. 汪冰霞,周树平,孙鸿辉.电针合并抗抑郁剂治疗抑郁症的临床观察[J].北京中医杂志,2003,22(2)：5-7.
7. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, et,al. SSRI-induced sexual dysfunction:fluoxetine,paroxetine,sertraline,and fluvoxamine in a prospective, muticenter,and descriptive clinical study of 344 patients[J].Journal of Sex and Marital Therapy,1997,23:176-194.
8. Fisher LD, Dixon DO, HersonJ, etal. Intention to treat in clinical trials.In:PearceKE,ed.Statistical issues in drug research and development. NewYork:Marcel Dekker,1990:331-350.
9.邱艳明,时宇静,图娅.电针印堂、百会对获得性无助大鼠不同脑区内单胺类神经递质的影响[J].北京中医药大学学报,2002,6(25)：54.
10.李卫东,杨秀岩.电针对慢性应激抑郁模型大鼠行为与海马组织环磷酸腺苷水平的影响[J].中国行为医学科学,2007,12(16)：1060.
11.孙海霞,杨蕴萍.抑郁症和焦虑障碍共病的研究现状[J].国外医学,精神病学分册,2003,3：166-169.
12. Heiligenstein JH, Faries DE, Rush AJ, et al. Latency to rapid eye movement sleep as a predictor of treatment response to doxetine and placebo in nonpsychotic depressed outpatients[J]. Psychiatry Research,1994,52:327-339.
13. Hatzinger M, Hemmeter UM, Brand S, et al. Electroencephalografhic sleep profiles in treatment course and long-term outcome of major depression: association with DEX/CRH-test response[J]. Journal of Psychiatric Research, 2004,38(5):453-465.
14. Agargun, MY, Kara H, Solmaz M. Subjective sleep quality and suicidality in patients with major depression[J]. Journal of Psychiatric Research,1997, 31,377-381.
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